As clinicians, you've probably noticed the recent uptick in joint replacement surgeries.
Knee replacements are the most common form of arthroscopic surgery, with an estimated 500k being performed annually, along with over 175k hip replacements - and those numbers are on the rise. In fact, hip replacements are expected to increase 174% in the next 20 years, and knee replacements will be increasing by an astounding 673%, according to a study presented at the American Academy of Orthopaedic Surgeons (AAOS).
So, what’s behind this increase?
Many blame it on the lifestyle of the baby boomer generation, who are not willing to be sedentary or change their lifestyle. Many active boomers' joints are deteriorating, and they want to continue doing the things they're used to doing as they age.
The baby boomer generation tends to forget their body’s age while exercising, and too often, may end up damaging hip and knee joints in particular.
This has brought about a new term in the orthopedic world—“boomeritis”—coined by Dr. Nicholas DeNubile, an orthopedic surgeon at the Hospital of the University of Pennsylvania in Philadelphia.
When middle- aged patients over-stress their aging body parts to the point of requiring drastic treatments, a few of the ailments diagnosed include tendinitis, bursitis, and arthritis—all conditions further exacerbated by continued activity if left untreated.
Osteoarthritis, or degenerative joint disease, can be particularly debilitating and often requires replacement surgery. Until now, both knee and hip replacement surgeries used to be primarily associated with the Medicare population.
That’s changing with boomeritis on the rise; over the last 10 years he says there was a threefold increase in knee replacements among the 45- to 64-year-old age span.
To get the exercise required for maximum health and avoid joint replacement, baby boomers can be proactive in their approach to healthy joints by strengthening the muscles around the knee through low-impact fitness programs. They should avoid most exercises that involve high impact and deep knee bending. Walking is a simple exercise that has been shown to reduce pain associated with knee arthritis.
Biking, treadmill walking, using the elliptical machine, and swimming are also examples of low-impact exercise. A daily stretching routine that focuses on back, hips, knees, and calf muscles aids in maintaining greater flexibility to muscles and tendons that stiffen with age and become more prone to injury.
If diagnosed with degenerative joint disease in the knee, several treatment strategies have been proven to alleviate pain and improve function, at least in the short term. They include a combination of the following: patient education, weight loss, physical therapy, medications, and bracing.
When Surgery is Needed
When all of the above treatments have been exhausted and the patient’s daily pain level affects quality of life, joint replacement surgery must be considered.
Both hip and knee surgeries are performed to replace the weight-bearing surfaces of these joints. The surgeon cuts away damaged bone and cartilage and replaces it with an alloy of cobalt, chrome, or titanium and a plastic compound called polyethylene. New technologies are designed for much better wear, which in turn improves the longevity of the prosthesis, which runs 15 to 20 years.
Most hip and knee surgeries are for complete or total replacements versus partial replacements. That’s true for the knee, since it’s the largest joint and the most easily injured. Because it’s broken up into three compartments, it’s rare that only one compartment is diseased.
Partial knee replacement is less invasive and requires minimal violation of the bone and soft tissue around the knee. Rehabilitation is usually accelerated, and patients often report that their replacement knee feels very much like their native knee.
However, many patients who seek treatment for the pain caused by knee arthritis are not candidates for the less invasive surgery, since they exhibit more than one diseased knee compartment.
In the end, total knee replacement remains the gold standard for the treatment of knee osteoarthritis and pain and restoration of function.
Post-surgery, a return to low-impact athletic activities, such as golf and bicycling, is very realistic, while actions that put stress on the knee—running, jumping, squatting—should be avoided.
Promoting preventative measures for healthy living can eliminate or at least put off the necessity for a knee or hip replacement by maintaining a healthy weight and exercising regularly. The best exercise is low-impact aerobic activity for endurance, range of motion exercise to maintain flexibility, and strength training for muscle tone.
Ultimately, whether it’s through injury, excessive weight gain, osteoarthritis, or as a result of genetic factors, the degree of daily pain in either will dictate the patient's decision for replacement surgery.
The Role of the Joint Replacement Coordinator
The responsibility of the joint replacement coordinator, most often an RN, is to run the facility's joint replacement program. They see patients prior to surgery and conduct all of the preoperative classes in order to educate the patients about what to expect and how to prepare for the surgery. They also provide education for staff nurses on new technologies and protocols.
With direct access to physicians and surgeons, the joint replacement coordinator facilitates many aspects of patient care. Following surgery, the coordinator rounds on patients every day and helps manage their pain.
In terms of complying with The Joint Commission (TJC), there are disease-specific requirements that need to be met. TJC certification is granted based on programs’ consistently achieving high outcomes, providing excellent customer service and nursing care and following standardized surgical procedures. The coordinator's job is to ensure compliance with all of these requirements.
Clinical skills to assess pain are also very important, as are communication skills to facilitate the education of both patients and staff. Have you ever thought about working on the joint replacement floor or becoming a joint replacement coordinator? Leave us a comment!
To help organizations meet the requirements of The Joint Commission’s new Advanced Certification for Total Hip and Total Knee Replacement, Lippincott Solutions and Joint Commission Resources (JCR), TJC’s publishing and education affiliate have co-developed a new series of 8 courses on Joint Replacement.
These new courses are available in the Lippincott Professional Development Collection competency validation and management software for institutions, and complement the other previously co-developed JCR courses on heart failure, stroke, compliance, and patient safety. For a FREE preview of the Joint Replacement courses and others in the Lippincott Professional Development Collection library, click HERE.